Agenda item

To consider the report of NHS England to engage the Board on development within specialised commissioning including co-commissioning

The Board considered the report submitted by NHS England on developments within the commissioning of specialised services in Leeds this year. The report also addressed anticipated future challenges, including current national consultations and service reviews, and provided an update on co-commissioning in Leeds.

General discussion noted the following:

-  Leeds has the largest Teaching Hospital Trust in Europe

-  acknowledged that patients who lived closer to specialised service providers were most likely to receive a specialised service, the challenge being how to give access to those further away.

-  the 7% annual rise on spending for Specialised Services was not supported by a similar rise in the total NHS budget and consideration had to be given as to how best utilise that resource through partnership working, care pathways and prevention pathways

-  noted that specialised services were the most contracted services in Leeds, providing HWB with an opportunity to identify areas of expertise and investment

Moira Dumma, NHS England presented the report which contained three key questions for the Board to consider

How can we work together going forward to locally and regionally address the issues of rising demand, demographic and population factors and increased demand for specialised services?

-  The 10 West Yorkshire CCGs and local Health Scrutiny Boards were working collaboratively on specialised services

-  the issue of how providers were collaborating was raised.

-  HWB consideration of collaborative working would need to look wider than Leeds and also have regard to fact that health providers were set up to compete against each other for award of contracts

What opportunities exist for collaboration to address key risk factors already in HWBB plan, eg smoking, obesity, alcohol, which impact on demand for specialised services?

-  Noted that LTHT had an established Prevention Policy place and the intention for LTHT to liaise with the CCGs

-  Considered that often same response is made annually to the same issue, which can result in a plateau of improvement. Increased support and/or innovation from NHS E would be welcomed

-  Prevention remained a key issue, however it was acknowledged that successful prevention equated to longer life and subsequently a greater call on specialised services later in life. At some point, an ethical discussion would be required on treatment in later life/end of life care

How can NHS England engender an approach of the culture of trust and transparency in decision making (in relation to new models of care for the delivery of specialised services)

-  Recognition that reconfiguration of services raised concerns amongst service users over how that change was communicated to them. Key issues being how families remained in communication with a family member receiving treatment at a distance and the stress and strain this added to families in what were already difficult circumstances; and how service providers provide support in those instances

-  Recognised the need to work with providers and to network services to minimise the number of visits required to the central point of service provision

-  The role and relationships of the Leeds CCGs with service users and the need for clarity on the opportunities for CCGs to have an impact on prevention and specialised services

-  HWB supported the continuing involvement of Leeds Health Scrutiny Board and the regional Joint Health Overview and Scrutiny Committee

-  The need for NHS England to be consistent throughout a consultation process on the review of any given specialised service and for greater openness and transparency about the impact of that service reconfiguration on the public and service providers.

The Chair referred to the recent consultation on proposals for Children's Epilepsy Services and her concern that the remit of the consultation had changed since the start of the process. She stated her intention to reply on behalf of HWB, and to raise the issues of travelling time/distance as a key concern for those in receipt of acute treatment, and that clinical and social needs be considered holistically. Finally, the Chair reiterated that early sight of any consultation and decision by NHSE was required so that HWB could inform into the process

RESOLVED – That the discussions and issues raised during consideration of the three ‘key questions’ set for the Board by NHS England in section 5 of the submitted report, be noted